Hey wait what? What are you still doing here? The average time we look at anything online is 3-8 seconds. Poof! There’s another big portion of followers gone just with stating that stat! But, you see, if we are so quick to think we have all that we need from something, that we’ve deduced its true meaning & reached solid conclusions, all based on a glance at a curated Canva or AI-generated image & accompanied by not more than 125 characters (for maximal “scannability” on socials according to AI) what are we missing? Substance.
In this last week I have literally had people express genuine surprise that a) contrary to my word I have not retired from group mentoring b) but gee I really should given how much it’s accelerated my ageing process
And if you’re still reading this dear-wonderfully-off-trend-outlier-friend I hope you are laughing and crying simultaneously. Craughing, is the technical term, I believe. And at all of us. I mean I am not always an exception. I have routinely said to my team when they’re creating emails or long product descriptions or anything notably not capped at 125 characters…”No one is going to scroll down that far! I would not scroll down that far!” But as a result, look at the mixed and missed messages we’re getting?!!!
Please note I have indeed hung up my group mentoring hat 🎩 Our new offering is a packaged up series of recordings of our previous very popular New Grads program
And (ahem) that image of ‘old me was photoshopped…& quite frankly I’m concerned I need to clarify 😮
So what else are we missing with all our very busy looking at everything but actually at nothing habits? A lot. I try to keep my tirades tight. My synopses succinct..in fact I think you’ll find under 30mins (mostly)!!! But if you haven’t got that long to spare…well…😶 🎤
“It takes me exactly 30 minutes (give or take Melbourne traffic) to get from home to work and my favourite drive is when the latest RA UU30 podcast comes out. Usually I have to listen again when I arrive so I can scribble notes down to remember the Aha moments that invariably leave me wishing I was at a traffic light with a pen…
Rachel, I am continually inspired by your dedication to the naturopathic profession and so grateful for the information you so generously share. Your contribution is unique and invaluable. Your enthusiastic passion for everything you present is contagious and leaves me loving what we do more and more each time I see or hear you speak.”
CHARMAINE DENNIS | Founding Director & Naturopath at Fertile Ground Health Group
I certainly pride myself on possessing an impressive level of endurance for an argument, as most of you surely know 😊 But the record for this is held by all practitioners of nutritional medicine. Because we’ve actually been debating the same 3 facets of what makes a good iron form since the late 1800s!🤯 Inorganic vs organic, soluble vs insoluble and ferrous vs ferric state! And for those playing along at home, I heard that & I have to tell you your ideas about iron have passed their ‘best before’!
Even the idea that these 3 aspects are central to the success of any oral iron supplement. Wrong. You’re welcome 🙂
Because this ignores all that we’ve learned (and had to unlearn) of late about iron digestion, absorption& regulation. And I would know! Eight years ago I released an episode, the ‘definitive’ download called, ‘So You Think You Know The Best Iron Supplement’. Recently, I re-listened to it like this 🙉 thinking it too might be past its use-by. But you know what? It isn’t. I was right about the lack of difference in overall efficacy between bisglycinate, citrate, gluconate, [insert any non-haem chelate or salt] & even sulphate forms! But that was then and this is POW! 💥
That’s the sound that’s made as yet another new supplement hits the market & throws us all into the ropes of the boxing ring 🥊 Leaving us scrambling to keep up, catch up & keep our heads off the canvas with all the new must knows!
Which now includes knowing all the important stuff about every new iron option…and there are a lot! From patches to (nano)particles, the resurgence of rewilded ‘herbal’ iron tonics, pea and other plant ferritins and of course organ meats and so SO much more. These new preparations are wildly different. Not only as a reflection of different product preferences, as an extension of our principles and prescribing philosophy but the very way they behave in our digestive tracts and beyond is not the same. And accordingly, each form arguably a particular ‘fit’ for a certain clinical context. So, are you absolutely clear about which form of iron when? Best you go check your ‘best befores’ on your beliefs about iron supplements….I’ll wait 😉
One of our most popular past episodes explored the relative efficacy of the many iron supplements on the market. Since then, the landscape has changed dramatically. New and novel forms have emerged — including haem iron products, phytoferritins, nanoparticles, dermal patches, and more — each claiming to solve long-standing issues with iron interventions. In this episode, we begin by retracing the evolution of iron as one of nutritional medicine’s most commonly prescribed interventions. From there, we examine the renewed interest in food as medicine and food-like forms: molasses and grape syrup, offal, iron-rich herbal tonics, and naturally iron-containing mineral waters.
To do this properly, we revisit some of our long-held assumptions about what makes a “good” iron form and hold them up against emerging evidence that is reshaping our understanding of digestion, absorption, regulation etc. It’s time to rethink iron — and update old ideas in light of new science.
You can purchase Iron: Primal Nutrient to Primetime Prescription here. If you are an Update in Under 30 Subscriber, you will this episode waiting for you in your online account. You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
Yeah nah — I’ll settle for the increasingly old me, thanks.
Vanity aside (and ouch, by the way), I’m perfectly happy remaining Insta‑unsuitable. I refuse to reinvent myself in the name of naturopathy meets neoliberalism, so I’m okay with being off‑trend. Liberated by it, actually. Because it means I get to focus on what matters more to me: that I’ve learned a lot — which, it turns out, required unlearning a lot too. Ideally softened with wisdom. Hopefully. I’ve taught many of you as undergraduates. Mentored many more. And somewhere along the way I seem to have helped birth a whole cohort of next‑gen naturopathic mentors and teachers. So yes — I’ve earned these age spots and laugh lines. And we all know I’m not done laughing yet.
And I am definitely not done with you.
I am the self‑appointed nagging Nanna of the naturopaths.
Forever pestering us about our potential — to do better, to be better. Forever banging on about aiming higher. Laying it on thick with my best “I’m not mad, I’m just disappointed” routine 🤣
I ask the questions that apparently hadn’t been asked yet… well, by anyone other than me (soz). From the ones we all probably should be across — like: • Where is the true sweet spot for nutrient dosing, where fractional uptake is maximised rather than squandered once transporters are saturated? • When so much of a supplement dose is left sitting in the lumen, what does that actually mean for our marvellous microbiome? • And when we insert nutrients into our nether regions to treat the taco… where do they actually go?
I ask. I research. I publish — because better answers make better practitioners. Honestly, search my site with almost any term. I dare you.
But I think that’s the role, right? The role of anyone a little further down the track.
To offer a view of the profession from a different vantage point. To ask questions that are sometimes uncomfortable. To set some goals — and then gently (or not so gently) nudge us toward them. Because we’ve had longer to ponder. And because us Nannas — we’ve seen every season of this profession. Every bloody episode of every bloody season tbh. Every wellness trend too — which are now officially just looping 😵 And we are no longer falling for any of it.
But whatever you do, don’t call me an Elder. Don’t offer me your seat on the bus (yes, someone actually did this the other day). Because you might suddenly discover what decades of healthy eating, peak physical condition (lol), and strong mental acuity can do… when combined with a slightly dodgy knee 👵😅
There was indeed food & drink & merriment galore but a good holiday season for me is about having the conversations. With family, friends, my professional peers. This is the real feast. In this strange period between one year and the next, portals appear to open up of a different space-time continuum. With the work-clock temporarily paused and screens no longer screaming for our attention, it allows many to engage more deeply, more reflectively. The conversations I’ve had the privilege to participate in & the people I’ve shared those with, are as diverse as we are & reflect something as multi-dimensional as all the ways we may find ourselves working in this space called ‘health’.
From those living life on the edge thanks to big business enterprises – to tales from the trenches of solo-practitioners
Educators impacted by institutional changes and the illusion of an ‘all-knowing’ generative AI
Pioneers of practice or prescribing models
Individuals beautifully representing us on the global stage (research) just as much as at a local level (retail)
Elders asking themselves, ‘What’s next for naturopathy?”
I listen lots & say little. It’s all grist for the mill that is my mind and I never quite know where, with all this input, my thoughts will end up. But I do know this is the nourishment I need to continue caring deeply about the profession whilst also updating my understanding of what being a nat/nut/herbalist/IM doctor means for many of you. And to reflect on my own role. As you may know, career-wise I have closed a door, to let others open. Mentoring hundreds of practitioners every year for over a decade was a great privilege. Delivering training in diagnostics and establishing frameworks for nutritional prescribing – are just some big highlights across decades of delivering education and training to all kinds of health professionals. And I am so proud of what I have produced and contributed to our collective knowledge.
Ideally, healthcare education providers shouldn’t feel like businesses at all — they should feel like institutions in formation
We have some exceptional home-grown examples around us, who are indeed institutions forming in front of our eyes. However, other aspects of the educational and mentoring landscape today are almost unrecognisable. I worry it’s being driven more by profit than purpose and is being delivered, on occasion, by those overflowing with enthusiasm but not experience. Just more food for thought. The conversations keep coming and I welcome them all.
As part of our current audio series on the pros & cons of non-enteral administration of our medicines, we’re finally up to the foof. The vajayjay. The bajingo. The coochie. I mean what exactly does happen when we start delivering nutrients direct to this target tissue?! Do they just lurk within the lumen? Do they get taken up into the epithelium? Do some break curfew and sneak right over into our systemic circulation?
What do we need to know if we’re inserting things into our nether regions? 🍑
The history of food as medicine delivered straight to the foof makes for a great read & features some of my favourites (foods that is), garlic, wine, olive oil, yoghurt. But we’re a long way past inserting the occasional clove up there. Increasingly, we’re finding reason to employ evidence-based intravaginal therapeutics: Zinc washes, Vitamin A, D and E based pessaries or good ol’ boric acid (popping into a peach near you since the late 1800s!) But whenever we deliver nutrients or herbs into the body via anywhere other than the gut there are a series of questions we should be able to answer to ensure this approach is both successful and safe.
In this episode we also visit up the bum, inhaled into the lungs and even atop the eyeball!
Can we cut out the middle man with our medicines and just deliver direct to door? To any mucosal target tissue with an accessible opening to the outside? When could we? When should we? When does it still make more sense to go back to standard supplements and boost blood levels? Oh you can bet there’s plenty to talk about here and a plethora of fun puns to be made. This is just yet another moment I am so glad we have a real live awesome human transcribing our audio for you…I can only imagine what R rated romp AI might have turned this into!🤣
With trends of innovation heading towards novel offerings sending nutrients anywhere but the mouth, Where Next for Nutrient Delivery? takes a curious look at what these alternative routes can genuinely offer. This episode celebrates where local applications—intravaginal, lower bowel, lower respiratory and ocular—make real clinical sense, whilst at the same time, keeping one foot firmly on the ground, reminding us why the humble gut still does a very good job for most people, most of the time. A sharp, physiology-first look at what must change with our medicines when nutrients interface with different epithelial linings & environments —and why novelty alone is never a good enough reason to change the route.
You can purchase Where Next for Nutrient Delivery? here. If you are an Update in Under 30 Subscriber, you will this episode waiting for you in your online account. You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
After not seeing her for some time I messaged my longstanding (or should that be long suffering? 😂) psychologist chasing up a contact. Much to my astonishment she rang & left a voice message along the lines of, “Great to hear from you, I often think of you and would love an update if you want to call me back.” So I did.
I mean this was an unmistakable demonstration of care. More than that, it potently evoked a sense in me of mattering. And in this instance, mattering in the mind and crazy busy world of this exquisite professional with decades of experience and oodles of clients. And well it made my day, my week, my month… & reminded me all over again why I choose her.
The construct of ‘Mattering’ is making the headlines in health right now. It’s being proposed as the missing piece of the mental wellness puzzle psychologists have constructed around other identified important elements, such as, self-esteem, social-connectedness and resilience. But many real barriers block or impair access to one or more of these for some. Think about individuals affected by social disadvantage and the inherent inequity then in the ‘resilience’ asked of them. Another example could be people who are neuro-divergent and might therefore struggle with social connection. Mattering in its most simple terms is the sense that we matter.
“Mattering is the personal sense of feeling significant and valued by other people. The person who feels like he or she matters is someone who feels important, visible…Mattering is a vital construct and a key psychological resource that is central to the human condition; indeed, the individual person who lives his or her life devoid of a sense of mattering to others will lack the basic sense of personal significance, human connectedness, and social acceptance required to thrive and flourish. In contrast, the person who feels a persistent sense of mattering unconditionally to significant others will have a key inner resource that fuels positive responses to life challenges. That is, a clear sense of mattering can buffer various life stressors.” Flett 2022
So this year I’ve embraced two new(ish) potent therapeutic modalities: mattering & active hope, & building up a sense of both in anyone I engage with. I spoke at two conferences on the latter, which has now been identified as an essential element of positive outcomes from any health intervention. I think both are things that are at the heart of naturopathic care but in all the clutter, confusion and chaos of biochemical pathways, nutrigenomics, testing & yet more testing, spruiking to socials for our survival etc. they may have been a little lost amongst the noise. But perhaps now as we prepare to take a break and spend more time resting and reflecting we can take a moment to contemplate how our patients’ sense of ‘mattering’ adds to any other medicine we might have prescribed🤗
What if the most powerful part of your treatment plan isn’t what you prescribe—but what the patient leaves believing? In this episode, we challenge the idea that better outcomes come solely from more precise diagnoses, more detailed testing, or more targeted interventions. Instead, we explore how the therapeutic interaction itself shapes patient physiology, behaviour, and engagement through three core drivers: mattering, expectancy, and active hope. Grounded in behavioural science and clinical insight, this episode unpacks how these forces influence outcomes—and how clinicians can intentionally design for them in practice. If you’ve ever wondered why technically “perfect” care doesn’t always translate into results, this conversation will change how you think about what actually makes treatment work.
You can purchase The Medicine Beyond the Bottle here. If you are an Update in Under 30 Subscriber, you will this episode waiting for you in your online account. You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resourceshere.
… to its target tissue, wherever possible. Yes I’ve been reading everything I can get my hands on regarding what happens when we ‘deliver medicines differently’, as part of my Supplement Boom Series. Medicines being: nutrients, herbs, pharmaceuticals. ‘Delivered differently’ includes: on the skin, across the oral lining, up the nose…and I’m entering other orifices, as we speak (!), in preparation for our next Update in Under 30 episode. And what is already abundantly clear is standard supplements are not the best route for every remedy.
And ol’ mate Iodine is such an excellent illustration of this.
Such a critical mineral for us humans, from an evolutionary and ecological perspective, performing important roles related to health, far beyond the thyroid: roles in redox, as a protector of lipid bilayers, anti-inflammatory, trophic regulator, homeostatic signal, highly effective anti-microbial etc. Yet whenever you boost blood levels of iodine, it’s the thyroid that becomes the bottleneck. It takes the lion’s share of whatever is circulating (sometimes up to 80%) even if that’s not where you wanted the iodine to go. So for patients who need that iodine elsewhere – within other body openings to maintain microbial balance say, well, wouldn’t we be best to deliver it right to their doorstep, instead? In a word – yes
Iodine has a long history of use as a topical treatment with broad & diverse applications.
In douches for a range of vaginal infections, intranasally at the first signs of a cold, as povidone at a low concentration, with evidence of efficacy. Delivering direct to the desired target tissue means we can use much lower doses and produce a more potent local effect – without the extraneous and unwanted effects from a much larger oral dose that will be widely distributed and dispersed. Zinc, of course, is another established hero ( ?Or is that anti-hero…have a listen to the episodes!) of ‘nutrition delivered differently’ & local therapeutics. But topical treatment of any tissue – the nasal or oral lining, the vagina, the colon, the respiratory tract etc – comes with its own cautions and concerns. For example, how the active, while therapeutic, may still vary in terms of mucosal compatibility – is it drying, caustic, damaging or disruptive in some other way? As well as, to what extent it’s being taken up and into where? Into the circulation to boost blood levels, to some extent, being the most common, of course. And in the case of iodine we’d need to be careful then because we may find ourselves back at that bottleneck, right? But in the case of intranasal applications, there’s also the-not-insignificant-issue of direct brain deposition…so why – oh why – something as scary as silver is available as a nasal spray <GASP> but currently intranasal iodine isn’t, I will never know.
Sounds like someone needs to revisit intranasal pharmacokinetics, no?
In fact, while we’re here…let’s look a little deeper into all the lovely places we can stick our supplements(!) – their strengths and weaknesses such that we can be clear about where to deliver them
Nutritional medicine is taking an unexpected turn—up the nose. In this episode, we unpack the rising interest in nutrient-based nasal sprays promising local, systemic and even central effects. But bypassing the gut is never straightforward. After a quick nasal A&P refresher, we cut to the evidence on what intranasal delivery can genuinely offer … and what might just be a whiff of wishful thinking.
You can purchase Intranasal Delivery – Nutrition’s New Pathway? here. If you are an Update in Under 30 Subscriber, you will this episode waiting for you in your online account. You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
I’ve been talking about the DMT1 transporters importing iron & other divalent metals – including their presence in our nose <GASP> – since the turn of the century <GASP GASP>. This helps to explain, of course, the profound neurotoxicity, for example, of inhaled Manganese and Mercury – via the potent pathway called: ‘nose to brain delivery’. But that’s just the tip of the nose…’s capacity for picking up nutrients, as it turns out.
Every epithelial border has a different set of rules for which substances are ‘permitted passage’
Our skin, no surprises, is the most selective of all, allowing very little in
And the hostile environment of our mouth, anatomically more akin to skin than the GIT, runs a close second in shutting the door
But the nose is always open for business, baby! (just ask any addict)
And this, of course, is attracting much attention in delivery design innovation in both pharmaceutical & complementary medicines. So while nasal sprays, containing some herbs maybe some nutrients, for the treatment of hayfever or the common cold, have been around a long time, the next gen of intranasal applications are not tying themselves to topical effects alone – in fact they can boost blood levels of any nutrient you choose, faster than other preparations, outside of injections. And then the next gen – next gen (!!) are not even content with getting actives into our capillaries, to reach their targets, but bypass the whole shebang including the BBB to deposit them directly into our brain.
Sound too sci-fi? It’s not
The potential here, for putting complementary medicines up our nose, is equal parts thrilling and terrifying. And it’s imminent. And while we await more of these to evolve into commercially available products in the real world, you might want to rethink absolutely anything you put up your nose (yes including CM nasal sprays). Just sayin. So why not take my hand and together we’ll go into the furthermost depths of the nasal cavity for a comprehensive update on everything you need to know.
Nutritional medicine is taking an unexpected turn—up the nose. In this episode, we unpack the rising interest in nutrient-based nasal sprays promising local, systemic and even central effects. But bypassing the gut is never straightforward. After a quick nasal A&P refresher, we cut to the evidence on what intranasal delivery can genuinely offer … and what might just be a whiff of wishful thinking.
You can purchase Intranasal Delivery – Nutrition’s New Pathway? here. If you are an Update in Under 30 Subscriber, you will this episode waiting for you in your online account. You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
I’ve just finished laughing along to yet another comedy routine making fun of the current gen’s ‘obsession with water’. This comedian was nostalgic for the old days when, every week or so, we’d just ‘wet our tongue on a water fountain’ and that was our dehydration sorted! And while I laughed along and I am against the trend of fashion accessories masquerading as expensive water bottles right now …on that note though for a laugh, please do yourself a favour and watch Will Anderson’s take on this!!But here’s what is being missed in it all…
If you’ve studied nutrition anytime in the last century you would have been taught that 20% of our fluids comes from our food. Am I right? Remember all those calculations you had to do with dietary intake records etc? You’re welcome lol
But that was then and this is now. And UPF now make up a much MUCH larger piece of most people’s dietary pie (pardon the obvious pun!) and especially the younger generations. So what might this mean in terms of water intake?
An increased overall need for water due to excessive Sodium – the oldest & most potent dietary diuretic we know! Together with less actual fluid in our food
All up, according to some scribbly ‘back of the envelope calculations’, that could mean that those of us eating the most processed diets will in fact need approximately an extra 800ml!!! Yep. Deviation from expected fluid provision from our food = 300 mL + Increased requirements due to Sodium running rough-shot = 500 mL → ≈800 mL/day extra. So, put that in your designer water accessory and suck on it!
No really…please do I’m part mumma and half water-hog and I worry about everyone’s hydration!!!
It seems almost farcical to question the merits of hydration for our renal health but is this actually the truism we have been lead to believe? Where does the recommendation of ‘8 glasses a day’ come from and what is the level of evidence to support it and in whom? Or should we in fact be setting our sights on output ie. 24 hr urinary volume, over input. Do all kidneys love water – or does this relationship change with the progressive impairment seen in CKD which affects up to 30% of our middle-aged population? When does hydration become harassment?
You can purchase Water & Our Kidneys – Helping or Harassing? here. If you are an Update in Under 30 Subscriber, you will this episode in your online account. You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
I know you know I’ve had a very public falling out with iodine. First up, I was its biggest fan then over about a decade I became its very vocal detractor. So what happened to create such a change of heart? It’s undeniable that our dietary intake increased and simultaneously the iodine amounts in supplements, without any accounting for the former. And bingo! Bad stuff happens.
And now the NHMRC is about to lower the levels deemed safe for exactly this reason.
Yes you heard me. A full review of the Iodine NRVs is underway and while no changes to the RDIs are being proposed, they have recognised a need to reduce Iodine’s UL recommendations for almost all age groups (except young children). Why? Because the science absolutely supports it. And you know what? I say the sooner the better.
Because currently, we have crazily high iodine quantities in our prenatals in particular. With companies promoting & priding themselves on pushing their iodine content up to the maximal permissible level, providing the full RDI for pregnant or breastfeeding women.
So that presumes these women aren’t getting ANY dietary iodine so we have to supplement the lot? Despite all the most recent data even on just ‘average’ iodine intake revealing women of reproductive age consume 125-150mcg/d from the ‘average diet’ alone. Yet we’re dosing our TTC clients, the same women that are on these nutrient-dense diets we recommend during precon and pregnancy, with the another 220-300mcg/d. And we’re also assuming they have ZERO thyroid antibodies then?!
Because you would never willingly mix these high iodine exposures with pre-existing thyroid antibodies in a pregnant milieu. Right?….
So it seems like we have to have this conversation and change our prescribing practices right now, whether we want to or not. So why don’t we support each other to do that well? Dig into the science together, get all our questions answered, collaborate on new, more evidence-backed & personalised prescribing for pregnancy. We need to stop and act now to protect our professional reputation and role in preconception and pregnancy care not find ourselves to be on the wrong side of health history with supplement safety.
Cracking the Case Series: Postpartum Thyroiditis – Risks in the Rearview, Remedies & Resolution
Odds are, you see women who are trying to conceive or are already pregnant. Odds also are that their likelihood of developing postpartum thyroiditis might be higher than most, but do you always know how to spot this? And from there, how to optimally assess them moving forward to know how their static risks they started with, are responding under the influence of pregnancy and postpartum physiology. If we can be clear about this and their shifting PPT propensity, then what we have is an opportunity for effective risk mitigation. In this PPT case we take a look in the rear view at what her risks were, where we could have redressed these and now ask the question, how to treat the PPT and avert permanent hypothyroidism. This case discussion comes together with an extraordinarily helpful clinical tool summarising assessment timepoints and interpretation along with appropriate treatment with each new level of risk identified.
Join our upcoming Watch Party on Tuesday 2 December at 6pm AEDT to have all your burning questions answered. This will include a BONUS discussion regarding iodine supplementation. You can purchase Postpartum Thyroiditis – Risks in the Rearview, Remedies & Resolution here. Or the full second series of Cracking the Case, which includes this episode along with 4 other clinically relevant cases. Click here to purchase.
Last week I had the pleasure & privilege of spending time with REAL practitioners discussing a REAL case & being part of a REAL discussion and a REAL exchange of all our ideas & experiences. I know, how quaint! Because unlike the AI apps we’re all increasingly interacting with, we’re clinicians and we take theory from the safe confines of ‘science’ and test-run it in the real world: dealing with patients, pathology, products alike, everyday. As a result, as is so often the case, the ultimate gifts came from our interactive Q & A and chatbox, in the form of our opportunity for genuine exchange of ideas & experiences.
Comparing real world costs for pay out of pocket providers of Lp(a) labs (& a hot tip on those not charging at all!)
All the tentacle topics that extend out octopus style from one presentation or pathology marker: ‘While we’re here what should ferritin be for lowest CVD risk in women?”
Cross-referencing with other content from other education sources – putting it out there for everyone to benefit from -“Now I know why they assess Lp(a) in chronic UTI presentations!”
Genuine unfettered product suggestions, reviews & even whispers about new ones allegedly in the pipeline.
With information overload at all of our fingertips, what we need most right now is something else. Real cases rather than random facts (& factoids). Thoughtful application of ideas instead of AI slop. An opportunity for debate and discussion based on real world clinical encounters rather than just duelling between our respective LLM VAs…is this sounding familiar?
Because fountains of facts at our fingertips doesn’t actually increase our knowledge effectively…We need to go retro and get real!
Because, if you ever want to truly check you understand something correctly – AI is not the place. Not even for the theory be warned!!! Intentionally designed to ‘people-please’ to ensure you pick ‘IT’ and stay engaged, always…I mean come on…the premise that ‘the customer is always right’ is a dangerous one in this context, right?! In fact, this latest study describes how overwhelmingly sycophantic LLM are. “Sycophancy essentially means that the model trusts the user to say correct things,” says Jasper Dekoninck, a data science PhD student at the Swiss Federal Institute of Technology in Zurich. “Knowing that these models are sycophantic makes me very wary whenever I give them some problem,” he adds. “I always double-check everything that they write.” IYKYK!
“What an excellent insight and nuanced perspective!” it tells me on the regular…sheesh easy way to boost my ego and dangerously lead us all on our march towards the death of facts, science, objective knowledge…
So we are ALL apparently right. You are when you ask, but your patients are too…even when they and we are not!
Cracking the Case Series: Uncovering Cardiovascular Risk – Elevated Lipoprotein(a)
How do you conduct a comprehensive cardiovascular risk assessment? It should always include a Lipoprotein (a) result, having been declared the biomarker with the strongest indication of causality in both atherosclerosis & valvular aortic stenosis. But what use is getting this tested, if, when we identify increased risk due to elevated results, we have no means to lower it? Until now. This is a 57 year old female with a striking personal and family medical history, a peachy coronary calcium score, mildly elevated LDL-C but significantly elevated Lp(a). We describe in detail the meaningfulness of this, as one element in our understanding of her overall inter-connected health story and reveal the prescription and approach that got results. We also discuss the challenge that is inherent in both ‘uncovering risk’ in someone while remaining on the right side of hope vs despair and of the nature of CVD risk reduction which requires lifelong management.
You can purchase Uncovering Cardiovascular Risk: Elevated Lipoprotein (a) here. Or purchase the full second series of Cracking the Case, which includes this episode along with 4 other clinically relevant cases. Click here to purchase.
Orodispersible nutritional medicines are a colourful crew (buccal sprays, ‘melts’, lozenges, gummies galore) with mixed agendas: tasty (patient preferences & increased access); topical (therapeutic agents for the oral cavity itself) and transmucosal (a shortcut for nutrients into systemic circulation). And across the board their popularity is on the rise among complementary medicine consumers. Simultaneously, pressure continues to build for companies to carve out points of difference from their competitors’ products which all contain, let’s face it, the same ol’ nutritional ingredients…any new vitamins or minerals come your way of late? Right?!
One increasingly employed option is to ‘deliver them differently’ – whether that’s via the skin, across the inside of your cheek, under the tongue or offering an explosion in your mouth!
But in terms of how this actually impacts their actions, applications and efficacy – are you across these? Does the science stack up for some of the nut med newbies like GSH buccal spray? And are our old & gold offerings like sublingual B12 still secure in their superiority? I’ve done a deep dive on them all, assessing each on its own merits and I was surprised by what I found out!
This is the fifth episode in our Supplement Boom Series. A series that finally takes the time to reflect on the R & D space within comp meds and nutritional medicine, especially.
I’ve been racing to keep pace with all the new product offerings so that we can confidently prescribe in response to science not a hard sell. I’ve been investigating the new shapes and forms our supplements are taking especially as a response to the rapidly changing commercial landscape within which are some seismic shifts in customer values. Isn’t that us? As prescribers & experts in nutrition you might think that but we’re small fry in this equation – the biggest piece of that pie is the public – the end-stage consumers… And given the almost universal appeal of any option that suggests speed…So ‘rapidly dissolving’ is inferred and heard as, rapidly repleting’ by the lay person. But is it?
Melt-in-the-Mouth Medicine – Pros, Cons & Clinical Pearls
Orodispersible nutritional medicines have burst onto the scene in all shapes, flavours, and ambitions. In Melt-in-the-Mouth Medicines – Pros, Cons & Clinical Pearls, we unravel the three main subtypes—those designed to be tasty, topical, or truly transmucosal—and ask whether each actually delivers on its promises. From clever convenience to questionable claims, we explore the science (and sales spin) behind this rapidly growing delivery format, and share key clinical insights to help you discern when these fast-dissolving formulations offer genuine therapeutic gains—and when they might just leave a bad taste.
You can purchase Melt-in-the-Mouth Medicine – Pros, Cons & Clinical Pearls here. If you are an Update in Under 30 Subscriber, you will this episode waiting for you in your online account. You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
I keep rescue chooks from battery farms & recently two have been quite sick – so I sought the advice of the all-knowing & all-round extraordinary Mother Clucker who heads up this organisation. Up and down the highway I went, to their chook HQ & quasi-hospital. Every time I returned with more vials of powders, pills, emulsions, tubing to get the goods into their guts directly, stern instructions about the need to separate them out, both from the flock & each other (one is currently housed in a half wine barrel!), monitor how much water they’re consuming, observe their poos, palpate some part of chook anatomy called a crop (I had to google it) & be ready to report back every detail… and tbh my brain blanketed with post-it notes. But I also left each time inspired, incredibly motivated by the all-knowing Mother Clucker, committed to doing the best for my little ex-battery battlers.
But the execution…ai y iyi! It’s a full-time job…on top of my full-time job. And only one of these feeds me because my gals are all living out their best retirement at my place. Oh, and then there’s my other pets, my plants, my domestics & gosh I really do need to fit in sleep at some stage! I wanted to scream, ‘Hey Mother-Clucker! Chook-care is not the only thing I got going on over here!!’ Inevitably I falter then fail & then am riddled with remorse about it. Another visit…another injection of information overload, I come home re-committed & the cycle starts again.
But suddenly it dawned on me that this is perhaps how some of my patients felt in the past
So, let me ask you, who are you as a clinician now compared to who you were when you first graduated? After you’d been out in practice a while? Or even more recently than that, say, before the ‘big P’ changed all our practice realities? I was a boss lady.
My big asks of everyone, my patients, my colleagues & certainly myself, came from a good place, of course. I was a fountain of knowledge, capable of ‘fixing’ them, if they took my advice, all my advice, on board.
Often of course, just like me, they failed & then (worse yet) felt bad about themselves. They imagined themselves to be at fault, but I was. I was asking too much. Overloading them with info, expecting they had a truly remarkable capacity for change, beyond what behavioural science suggests is likely and that nothing else in their lives would get in the way of this prescription. As a clinician some lessons are giant quantum leaps, but many are more like microdosing, it takes a long time of incremental insights but only after you’ve hit some threshold do you make the change and for me this was one of those.
But once you learn this lesson: the need to meet our patients where they are, individualise treatment to their readiness for change, co-create the prescription with them so they are already increasing the odds of its success, etc. Well, you’ll never be so hard on any human (including yourself) hopefully ever again.
Compliance Changers – Strategies for Success
At the end of an information & insight heavy appointment, formulating a list of products and doses for our patients to take can feel like a bit of a ‘tada moment’, like a magician pulling a rabbit out of the hat. “Here is the solution – now off you go!” Research tells us, however, that treatment-plans that are a co-creation between you and your patient – evolving from a discussion that not only allows them a voice, but a major role in the decision making – are far more likely to succeed. While we are the authority on our medicines, our patients are the authority on what makes them tick & what’s likely to succeed, in terms of taste, texture, temperature & timing! This is called Patient Centred Prescribing and together with some other tips tricks and hacks I share with you in this episode, can really increase patient buy-in, compliance and therefore bring your treatment plan to fruition and fulfilment!
You can purchase Compliance Changers – Strategies for Success here. If you are an Update in Under 30 Subscriber, you will find this in your online account. You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
I should have known. Right after I wrote my most recent blog on two essential updates in adolescent health – HealthEd released a podcast on Spotting Eating Disorder Red Flags in Children that lit my brain up like a pinball machine! Because I know for many it’s hard to access things on HealthEd given you do need to register and registration is somewhat restricted, I was trying so hard to sit on my hands BUT this 45min discussion with Michelle Boyd, a general paediatrician but specialist in this area, was sooooooo overflowing with really nuanced practice-changing information (potentially equalling life changing info for those individuals affected)…well, I just could not stay quiet 🤐 So while only listening to the whole episode yourself will do it justice…here are some critical concepts in the interim.
The number of children admitted to Australian children’s hospitals for eating disorders doubled in one year (2020-2021)
We all meticulously measure growth in young children – Why stop during such a critical growth stage such as adolescence & what do we miss if we do?
Any weight loss during this period is a red flag – and should be approached with a non-judgemental open curiosity What’s new? What’s changed?How does this feel?
Many screening tools for eating disorders used in adults are too blunt for this age-group and will undo your open & curious approach – use the Children’s Eating Attitude Test (ChEAT) instead & only administer the EDEQ to better understand the severity, if an eating disorder is confirmed.
Don’t leave this differential til last – thinking you’ll investigate every other possible explanation first, e.g. functional or organic GIT dx etc – this is a dangerous practice.
Dr. Boyd’s approach and advice to other health practitioners about how to keep EDs high up in your differentials while continuing to practice due diligence in your work up, is to flag it directly with the individual and their family, something along the lines of: “I am worried there’s an element of an eating disorder that underpins this, that’s really important for us to better understand and address for us to make the fastest improvements on how you feel”
I have a voracious and varied appetite for medical research but two things came up recently that I thought I just had to share:
Energy Drinks Increase Suicide Risk
Under the heading of, ‘New Red Flag for Mental Health’ Medscape reported on a meta-analysis involving 1.5 million participants, aged 15-48yrs, associating intake of energy drinks with substantial increases in both suicidal thoughts and actions. An increased risk was present even with irregular intake, such as once a month (still 37% higher). However, the most regular consumers, drinking energy drinks most days, demonstrated an almost 300% increase! In stark contrast, heavy coffee consumers (2 cups or more per day) were protected….Hmmmm I kinda had to question at this point whether they had adequately accounted for age as a variable. Because let’s face it, sadly these drinks and these types of feelings and thoughts of self-harm go together with the adolescent age and stage, much more so than any other.
So perhaps the contrast between the two beverage consumption patterns might be somewhat overstated in this study but this is not the first piece of research finding fault with energy drinks and our kids’ mental health – several large studies in different countries have raised the alarm before.
In an attempt to explain the difference, several theories have been put forward, including that it could be the combination of ingredients in energy drinks, especially the high sugar content, that specifically produce the perfect storm. Alternatively, however, as energy drinks typically contain anywhere between 75 to 300 mg per beverage and are usually consumed in much larger quantities than coffee, as a result of their intense sweetness – perhaps caffeine (not anything else in the energy drinks) is the only issue and this is just the result of extreme excess. Whatever the real reason, the important editorial note here is that specifically asking about energy drink intake should form part of our mental health screens in all individuals. Duly noted!
Next up… the incredible overlap in presenting features & yet missed opp for Ax of OSA(S) in kids attracting ADHD labels
So…every individual child flagged for ADHD should in fact undergo ‘at least one comprehensive in-house (not at home!) sleep study’ according to paediatric experts, because it could be the real reason behind these attention issues or is certainly making them worse and at-home assessments are notoriously unreliable in this age group. The trick is we’re not getting our usual triggers for referral because OSAS in kids and adolescents occurs outside of usual risk profiles and red flags in adults – it’s not necessarily linked to obesity nor snoring – though they note that if a child or adolescent exhibits, ‘ sleep talking, sleepwalking, sleep paralysis, and nightmares’ this in fact can be suggestive of OSAS. This article also speaks to the incredibly high rate of OSA in individual with Down’s Syndrome (>50%) I was today years old and a little late to this learning!
CPAP is not the solution in kids and with management of OSA in general becoming far more innovative – recognising and remedy-ing this could have enormous benefits for that individual, their health and their sense of self, for the rest of their lives.
“Cosmeceutical” sits between cosmetics and pharmaceuticals and probably makes you think of serums and skincare, and of course many of these products’ ‘active agents’ are in our lane: Retinol, Biotin, Collagen, Liposomal C and herbs. However, the new kids on the Cosmeceutical block are in fact patches, creams and gels all applied to the skin but whose claims suggest they supply us with nutrients and herbs, at least intradermally, if not systemically.But this term, for those seeking good science among us, should make us shudder because it’s just a portmanteau marketing peeps came up with, it’s not a legally recognised category — and in turn it is outside of the regulation of the TGA & FSANZ.
It’s a marketing term. That’s it.
So while the claims might sound clinical — “active ingredients,” “targeted results,” “scientifically formulated” — the truth is, they don’t go through the same scrutiny as real therapeutic goods. No mandatory testing. No ingredient oversight. No required proof. And even claims they offer our patients ‘transdermal delivery’ are often unfounded and any effects are only ever skin-deep.
When we think our usual supplements and entry points into the body aren’t hitting the mark in some patients, we start to think outside the box – certainly ‘around the gut’
And of course this can make sense and a successful solution, e.g. IM B12 in the case of IF anomalies. However, if ‘getting around the gut’ means we’re prescribing products that fall into the Cosmeceutical category and are about as regulated as face glitter(!) I think there’s some weighty cautions and concerns. And can I say with all due respect…I used to think more patients were refractory than I do now.
So what changed? The more research I read the more I had to accept that the way I had been taught to prescribe nutrients – didn’t in fact stack up with the very latest science. So I completely changed my prescribing practices…just let me know when you’re ready to learn too…
In the meantime…
Dermal Delivery – Is It Just Skin Deep?
With nutrient delivery options of patches, gels, creams and more on the rise, the promise of absorption via the skin is being sold as simple and seamless—but is it really? This episode unpacks the difficult path nutrients must take to initially enter the epidermis and then (more difficult yet) make it out the other side and to the rest of the body. Rachel identifies which essential vitamins & minerals as well as nutraceuticals, in their natural state, are ‘permitted passage’. In addition to this she describes exactly the nature and number of modifications necessary for others to circumvent the skin’s barrier function. Under the Cosmeceutical category, and subject to even less regulation than our breakfast cereal, claims of ‘transdermal delivery’ (having actions beneath & beyond the skin) are being applied to products whose effects may be strictly skin-deep.
You can purchase Dermal Delivery – Is It Just Skin Deep? here. If you are an Update in Under 30 Subscriber, you will this episode waiting for you in your online account. You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
Have you been tempted to prescribe nutrients in a cream in patients who aren’t responding to oral treatments? Or perhaps you’ve had patients come in all ‘patched’ already! Either way it seems like now is a great time for us to revisit the topics of skin anatomy, physiology and specifically its absorptive capacity.
As a get around for orally-intolerant patients, the skin, our ultimate barrier is a surprise suggestion…but we’d be wrong to view it as impenetrable.
Thankfully, there are clear criteria that must be met for anything (nutrient, nutraceutical, herb, drug, hormone, neurotransmitter etc etc) to be permitted passage. ..at least into the skin. Getting through all the cells of the dermis and then out the other side to the circulation to boost blood levels and produce actions elsewhere?… Well that’s akin to a backwards triple pike off the high platform! So which nutrients naturally make sense as topical or intradermal agents of change, great for a range of dermatological presentations ?
And which, either in their natural state, or with the assistance of cutting edge dermatological technologies, offer us truly transdermal treatments?
Where nutritional medicine trends take us – we must follow! So come with me and get confident when nutrients delivered via the skin are indeed viable 🐾
Dermal Delivery – Is It Just Skin Deep?
With nutrient delivery options of patches, gels, creams and more on the rise, the promise of absorption via the skin is being sold as simple and seamless—but is it really? This episode unpacks the difficult path nutrients must take to initially enter the epidermis and then (more difficult yet) make it out the other side and to the rest of the body. Rachel identifies which essential vitamins & minerals as well as nutraceuticals, in their natural state, are ‘permitted passage’. In addition to this she describes exactly the nature and number of modifications necessary for others to circumvent the skin’s barrier function. Under the Cosmeceutical category, and subject to even less regulation than our breakfast cereal, claims of ‘transdermal delivery’ (having actions beneath & beyond the skin) are being applied to products whose effects may be strictly skin-deep.
You can purchase Dermal Delivery – Is It Just Skin Deep? here. If you are an Update in Under 30 Subscriber, you will this episode waiting for you in your online account. You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
Did you know that any supplement that ‘identifies as a food’ is subject to the same regulations as a sugary breakfast cereal? Yep. So in spite of 30% sugar content – the packaging and all advertising around said cereal, claims it’s a great source of…
PROTEIN Bs IRON
!
It’s a pretty low bar right?! Same same for ‘Superfood’ based supplements. Whether that’s freeze dried vegetable powder, whose marketing suggests it substitutes for ‘X serves of greens a day’, when in fact it provides the equivalent of less than 1/2 cup of kale, or ‘Oceanic sources of Magnesium’, which is actually Mg hydroxide – the oldest laxative around, or absolutely any of the offal offerings on the market right now – the scope for what you can say about your supplement is outrageously broad. Oh and you don’t need any independent analysis of its actual nutritional composition. And even if you did spend the money to have this performed (which is the case for only 1/8 of these offal offering companies we contacted in Australia) – you don’t need to declare what’s actually in there – outside of those mandated in food: kj, macros, sodium. Because you identify as a food! In addition to this, label warnings are not necessary and the so-called ‘RDIs’ applied are generally lower than our actual requirements – certainly as women, let alone pregnant or breastfeeding – but in spite of this you can state absolutes like, ‘This supplement provides 100% of the RDI’! Even when it doesn’t for the key demographic you’re marketing to! Oh and where were you made? Same place as the sugary cereal. A factory that specialises in UPF production!
Sounds a lot different from our regular heavily regulated supplements right?
But chances are even us trained professionals have fallen for ‘comparing the pair’ – based on what’s stated on their label and in their marketing.
Let alone the poor confused consumers!!
Now of course Offal is so ‘in’ right now because of its word association with: ‘Wild’, ‘Ancestral’, ‘Primal’. All mega marketing levers currently employed for crushing the competition. But has anyone really thought the offal offerings through, based on everything I’ve just outlined? And like most ‘Superfood Supplements’ you’d be streets ahead (nutritionally, economically, environmentally) if you just ate it. I mean have you done the maths on 3g of liver or spleen? Do you know what its food equivalent actually is?
No??? Banh mi peeps!🙄 I mean do yourselves a Foie gras and the Morcilla maths!!!
Yes it’s time we had a talk about our Offal Obsession and all so-called ‘Superfood’ supps…so if you just follow me🚶♂️ 👣
Offal Obsessions & Superfood Supps – Rewilded or Just Wild?
In pursuit of prescriptions that better align with our philosophy and principles, product development that implies a ‘rewilding’ of our remedies is appealing to many practitioners. And our motto of ‘food first’ appears to marry nicely with the increasing options for easily ingesting medicinal foods (algae, offal, ‘supergreens’, berries), in the form of capsules, pleasant-tasting powders etc. However, what’s often not understood when selecting these kinds of supplements are all the other things we’re agreeing to, which are implicit to all supplements ‘identifying as a food’ rather than a medicine. This is the third episode in our Supplement Boom series, where we get real about what ‘Superfoods’ and our current Offal Obsession are truly offering us and the key concerns and cautions.
You can purchase Offal Obsessions & Superfood Suppshere. If you are an Update in Under 30 Subscriber, you will this episode waiting for you in your online account. You can become an Update in Under 30 Subscriber to access this episode and the entire library of Update in Under 30 audios and resources here.
To the people who make up our profession… I’m just back from attending the opening of the Melbourne Apothecary/ Mecca collaboration in Melbourne CBD as one of Charmaine & Carly’s VIPPPs… Very Impressed Proud Privileged People
Everyone who knew I was attending wants to know the details of this extraordinary evening & describe what these women (and a TEAM of awesome individuals alongside them) have created and achieved. I can only respond with a GIF that conveys…I don’t have the words, my mind is truly blown. And it is.
This is the culmination of 2 years of their non-stop efforts. Pitching, planning, problem-solving & preparing, on a scale that most of us can not even imagine. But it’s also off the back of Charmaine’s 20+years of doing more of the same, running pioneering fertility practices in Melbourne. These guys impress the pants off me. But it’s not just them.
I’m surrounded by nats, nuts and herbalists who have collectively achieved almost anything and almost everything. Some have established food production farms, others grow medicinal herbs at scale, build apothecaries either large and small, set up annual conferences to educate their colleagues and communities, write and publish books, have launched a podcast, go work for government, set up patient programs, run ground-breaking group consults, work in research taking our great work global, open a clinic in rural and regional locations etc etc. And the new grads I’ve witnessed take their very first steps, crafting and creating their very own business branding and logo, perhaps setting up an online business. And for those of us a little more seasoned…maybe to have just kept on keeping on, to have faced barriers and re-routed, to have fallen down and got back up again…seriously…it is all impressive.
So look around and you might just fall in love all over again too. We only need to see ourselves to be inspired ♥️
What a delightful high to finish our group mentoring programs on 🤓🤸 We know the calibre of practitioners that commit strongly to their ongoing education and upskilling. We see this in action via myriad reflections – check out just some examples of our most recent members of our alumni:
I’ve been mentoring with you for 5 years now… I’m pretty sure I was changing nappies in the first year… then I just had FOMO every year thereafter, so I would sign up AGAIN …. & AGAIN… & AGAIN! Leanne (Groups include: New Graduates, Cracking the Case, The Nutrient Prescriber’s Program)
I have been looking to deepen my understanding of nutrient prescribing since years. Here in Austria/Germany I have a lot of orthomolecular medicine studies, but all of that was not what I was looking for. And I now found what I was looking for and I am deeply grateful. Mariella (The Nutrient Prescriber’s Program)
I am getting ready to go in a few minutes as have a 3pm client Rachel. I am feeling a bit sad as this is the last one…I can’t say thank you enough for all my many years of mentoring – what you have taught me is beyond priceless. A thousand thank yous Rachel. Amanda (Mentee stalwart since 2018 ;))
Having the ability to ask qs as we go through and at the end now is so valuable which is why I always take the (live) mentoring option when possible. I am hoping there will be a Watch Party for Mastercourse II at some point? Leila (New Graduates, MasterCourse I, The Nutrient Prescriber’s Program)
I could never allow myself to miss out on the Update in Under 30. They are far too valuable. Dagmar (Student Pathology Hub, Update in Under 30 subscriber since 2018)
We see you all and we celebrate you! And for those of you buying a little online education to sneak in a lil’ Sunday session, those sending emails starting with: “I’ve done every single thing of yours on ‘X’ and just want to check my understanding about’…. the OS practitioners that get up at sparrow’s fart to make 1:1 mentoring sessions with me etc etc etc.
Watch out for these kick-arse clinicians coming your way! Another hot batch fresh out of the RAN oven!!
